降钙素原指导脓毒症患者抗生素应用的Meta分析

发布时间：2018-01-15 17:31

本文关键词：降钙素原指导脓毒症患者抗生素应用的Meta分析　出处：《中国循证医学杂志》2016年12期 　论文类型：期刊论文

【摘要】：目的系统评价降钙素原(PCT)指导脓毒症患者抗生素应用是否优于常规经验性抗感染治疗。方法计算机检索Pub Med、The Cochrane Library(2016年9期)、EMbase、Web of Science、CBM、Wan Fang Data、VIP和CNKI数据库,搜集有关PCT指导脓毒症患者抗生素应用的随机对照试验(RCT),检索时限均从建库至2016年9月。由2位研究者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用Rev Man 5.3软件进行Meta分析。结果最终纳入15个RCT,共3 328例脓毒症患者,其中PCT组1 649例,对照组1 679例。Meta分析结果显示:PCT组的抗生素使用时间[MD= 2.37,95%CI( 2.96, 1.78),P0.000 01]、ICU住院时间[MD= 0.26,95%CI( 0.46, 0.07),P=0.007]和总住院时间[MD= 2.78,95%CI( 4.53, 1.04),P=0.002]均明显短于对照组,且差异均有统计学意义;PCT组28天死亡率明显低于对照组,其差异有统计学意义[RR=0.78,95%CI(0.66,0.93),P=0.005];而PCT组ICU死亡率、院内死亡率及临床治愈率与对照组差异无统计学意义。结论 PCT指导抗生素的使用优于经验性抗感染治疗,不仅可以缩短抗生素的使用时间、ICU住院时间及总住院时间,还能降低脓毒症患者28天死亡率。但在降低脓毒症患者ICU死亡率、院内死亡率及临床治愈率上并未显示出明显优势。受纳入研究的数量和质量限制,上述结论仍有待于更多高质量RCT加以验证。
[Abstract]:Objective to evaluate systematically whether the use of antibiotics in sepsis patients is superior to that of routine experience in antiinfective therapy. Methods Pub Med was searched by computer. The Cochrane Library (2016 9) Cochrane of CBM Fang Data. VIP and CNKI databases were collected from randomized controlled trials (RCTs) that were used by PCT to guide antibiotic use in septic patients. The retrieval time was from the construction of the database to September 2016. After the two researchers independently sifted the literature, extracted the data and evaluated the bias risk in the study. Rev Man 5.3 software was used to analyze Meta. Results the results included 15 RCTs, including 3 328 patients with sepsis, including 1 649 cases in PCT group. Meta-analysis of 1 679 cases in the control group. The results of meta-analysis showed that the antibiotic use time in the 10 ~ (th) PCT group. [MD= 2.37 / 95 CI (2.96, 1.78 / P0.00001). [MD= 0.26N95 CI (0.46, 0.07% P0. 007) and total length of stay. [MD= 2.78-95 CI (4.53, 1.04% P0. 002) was significantly shorter than that of the control group, and the difference was statistically significant. The 28 day mortality in PCT group was significantly lower than that in control group, and the difference was statistically significant. [RRX 0.78 / 95 CIQ 0.660.93% P0. 005]; However, there was no significant difference in ICU mortality, hospital mortality and clinical cure rate between PCT group and control group. Conclusion the use of antibiotics guided by PCT is better than that of empirical anti-infection therapy. It can not only shorten the duration of antibiotic use, but also reduce the mortality of sepsis patients in 28 days, but also reduce the mortality rate of ICU in sepsis patients. The hospital mortality rate and the clinical cure rate showed no obvious advantage. Due to the limitation of quantity and quality included in the study, these conclusions still need to be verified by more high quality RCT.
【作者单位】：北京中医药大学东直门医院;北京中医药大学东直门医院心内科;北京中医药大学东直门医院ICU;
【分类号】：R459.7
【正文快照】： 脓毒症是感染导致的全身炎症反应,其临床发病率和死亡率均在逐年升高,治疗费用庞大[1]。控制感染是脓毒症治疗最重要的措施,合理使用抗生素也成为治疗的关键。降钙素原(PCT)是一种新型感染标志物,有研究显示其对细菌感染特异性高[2,3],其也因此被用来指导抗感染治疗。但其与传

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